Medicare and Ambulance Coverage

Ambulance services can be necessary for situations when the patient needs to be taken to the hospital at the earliest. For senior patients, driving may not be a feasible and safe option due to the reduced eyesight and slowed down reflexes. This is why; they may prefer to travel to a hospital in an ambulance in case of emergency as well as non-emergency medical appointments.

However, Medicare does not cover transportation by ambulance for normal appointments like routine doctor visits. Only some of the non-emergency ambulance services would be covered by Medicare. The following is detailed information about when Medicare covers ambulances changes.

Does Medicare cover ambulance?

Medicare covers non-emergency and emergency ambulance services provided certain conditions and requirements are fulfilled.

Medicare Part B covers ambulance charges borne while traveling to or from a hospital, skilled nursing facility, or critical care facility. However, the patient would be eligible for the coverage only when any other mode of transportation is deemed to endanger the life of the patient.

Medicare coverage, in such cases, includes ambulance transportation services to the nearest medical facility that can provide the care needed. You can choose any facility farther away; in which case, the coverage would depend on the charges to the closest appropriate medical facility.

In case the local facilities are not able to provide the care needed, Medicare would pay for transportation to the nearest medical facility outside of your local area.

Emergency Ambulance Transportation

Ambulance Transportation in case of emergencies to a skilled nursing facility (SNF) or hospital is available in the case of a sudden medical emergency and when other modes of transportation such as a car or a taxi are not safe.

Here are some instances when Medicare may cover emergency ambulance charges:

The patient is in a state of shock, bleeding heavily, or unconscious
The patient needs skilled medical treatment while being transported to the hospital

Other than these, Medicare coverage would depend on the specific medical condition of the patient.

Air Transportation

Medicare covers air ambulance services in emergency situations when the pickup location is hard or impossible to reach by ground transportation. It may also be covered when there is a risk that the long-distance or heavy traffic may stop you from receiving life-saving medical care quickly if you traveled by ground ambulance.

Non-Emergency Ambulance Transportation

Medicare may partially cover non-emergency ambulance services in the following conditions:

Ambulance transportation is essential for the diagnosis or treatment of your health condition.
The use of other transportation methods can put your health in danger.
The doctor has provided a written order stating the necessity of ambulance transportation.

When these situations are fulfilled, Medicare would cover 80% of the charges. Also, if the situation or your medical condition in which an ambulance is used meets the coverage criteria, and you also have a Medicare Supplement Plan C or F, you need not pay any out-of-pocket costs for these services.